To: Sonoma County Board of Supervisors
Department or Agency Name(s): County Administrator’s Office, Sheriff’s Office, Probation, Health Services, Human Services
Staff Name and Phone Number: Nikolas Klein, 565-5312; Connie Newton, 565-8884
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Agreements for FY 2021-23 Medi-Cal County Inmate Program
End
Recommended Action:
Recommended action
Authorize the County Administrator to sign the following documents related to the Medi-Cal County Inmate Program:
A) An agreement with the State Department of Healthcare Services for continued participation in the Medi-Cal County Inmate Program for the term starting July 1, 2020, remaining in effect until terminated by either party.
B) An agreement to reimburse the State Department of Healthcare Services for Medi-Cal County Inmate Program administrative services costs, for the term July 1, 2020 through June 30, 2023, for a not-to-exceed amount of $15,033.
C) Any additional forms or documents required for participation in the Medi-Cal County Inmate Program from the initial date of April 1, 2016 through June 30, 2023, provided that any such documents are approved by County Counsel and consistent with the provisions the approved participation and administrative agreements.
These agreements allow the County to continue participating in the Medi-Cal County Inmate Program and receive federal funding to cover a share of inpatient medical care costs for eligible inmates in the County’s detention facilities, which reduces the cost burden on the General Fund.
end
Executive Summary:
Approval of these agreements will allow Sonoma County to continue participating in the Medi-Cal County Inmate Program (“Program”) to utilize funding from Medi-Cal to cover the federal share of inpatient medical care costs for inmates who are eligible for Medi-Cal from July 1, 2020 through June 30, 2023. Through this Program, the State will pay approved claims directly to the hospitals providing services to inmates. In the event the State pays for any costs not covered by federal funding, the Agreement requires the County to reimburse the State for the non-federal share of these claims. The Agreement also includes State administrative costs of approximately $5,000 per year. This Program will cover both adult and juvenile offenders in the custody of the County.
Discussion:
Prior to implementation of the Medi-Cal County Inmate Program, the County General Fund covered the full cost of medical care for individuals incarcerated in either the County’s adult or juvenile detention facilities. The approval of three different pieces of legislation created what is now collectively known as the Medi-Cal County Inmate Program. AB 1628 in 2010 established the Adult County Inmate Program; SB 695 in 2011 established the Juvenile County Ward Program; and SB 1462 in 2012 established the County Compassionate Release Program. Since passage of these laws, the State Department of Health Care Services has worked to establish the administrative oversight to implement these programs, which allow the claiming of the Federal share of Medi-Cal funds for inpatient hospitalizations for these specific populations.
Until the Program was created in 2016, the County used General Fund to pay for all inmate medical care costs. Services are currently provided in the adult detention facilities through a contract with Wellpath (formerly California Forensic Medical Group), and in the juvenile facilities through a contract with the County Department of Health Services. Under the Wellpath contract, the County is responsible for any adult inmate healthcare costs in excess of $20,000 per hospitalization. With the implementation of this program in April 2016, the providing hospitals now directly bill Medi-Cal for services provided to eligible inmates, and Medi-Cal pays the provider at the approved rate. On a quarterly basis, the State Department of Health Care Services bills the County for the non-federal share of these claims (either 5% or 50%, depending on the eligibility of the individual).
Although the County began participating in this new Program in April 2016, there were system issues at the State level that delayed the issuance of payments until November 2017. Implementation of the Program in the adult detention facilities requires intensive, ongoing coordination between Wellpath staff, an enrollment counselor (contracted through Redwood Community Health Coalition), the hospitals, the County’s Human Services Department (responsible for submitting Medi-Cal applications to the State), and the State Department of Healthcare Services. The Wellpath agreement complies with the regulations of the Program. A subsequent amendment to the County’s Agreement with Wellpath was executed in May 2019 to allow the County to be reimbursed for 85% of the savings Wellpath is experiencing from the Program. Wellpath retains the remaining 15% of savings to cover its administrative costs related to participating in the MCIP. In FY 2018-19, these credits totaled $164,000.
In FY 2017-18, the Program was still being rolled out and a full year of activity did not occur. In FY 2018-19, the County’s costs to participate in this Program included State Department of Healthcare Services administrative fees ($4,545), and the cost of the Redwood Community Health Coalition contract ($37,756). In FY 2018-19, the County realized over $750,000 in savings by participating in the Program. These savings covered the costs of the enrollment counselor and program administrative fees. The County’s portion of non-federal costs was approximately $100,000; however, these costs would have been the County’s responsibility regardless of MCIP participation. The non-federal costs will continue to vary from year to year as these costs are based on the specific services provided to inmates. With the exception of RCHC’s staff, the Sheriff’s Office, Probation, and Human Services Department are absorbing the workload related to MCIP. Staff recommends entering into this Agreement for FY 2020-21 through FY 2020-23 to allow for continued participation and evaluation of the Program.
Prior Board Actions:
10/08/19 - Board approved the FY 2019-20 Medi-Cal County Inmate Program Agreement
06/12/18 - Board approved the FY 2018-19 Medi-Cal County Inmate Program Agreement
02/07/17 - Board approved the Medi-Cal County Inmate Program Agreement for April 1, 2016 - June 30, 2018.
Fiscal Summary
|
Expenditures |
FY 20-21 Recommended |
FY21-22 Projected |
FY 22-23 Projected |
|
Budgeted Expenses |
115,199 |
118,750 |
122,413 |
|
Additional Appropriation Requested |
|
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Total Expenditures |
115,199 |
118,750 |
122,413 |
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Funding Sources |
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General Fund/WA GF |
115,199 |
118,750 |
122,413 |
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State/Federal |
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Fees/Other |
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Use of Fund Balance |
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Contingencies |
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Total Sources |
115,199 |
118,750 |
122,413 |
Narrative Explanation of Fiscal Impacts:
The Sheriff’s Office FY 2020-21 budget includes $115,199 to cover program costs, including: $45,000 for the Redwood Community Health Coalition counselor contract; $4,769 for the MCIP Administrative fees paid to the State; and $65,430 for the County’s estimated MCIP share of non-Federal costs. Future year estimated costs for the RCHC contract and share of non-federal costs are estimated to increase due to inflation. The County’s total cost for Medi-Cal County Inmate Program Administrative Services shall not exceed the following annual amounts per the Agreement: $4,769 for the first year; $5,007 for the second year; and $5,257 for the third year. The estimated cost avoidance that will be realized from participating in the program is incorporated into the Sheriff’s Office FY 20-21 budget as reduced expenditures. The Sheriff’s Office is able to cover aforementioned costs for the enrollment counselor, program administrative fees, and non-federal share using General Fund monies that were historically allocated to cover catastrophic medical costs prior to MCIP implementation.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
None.
Attachments:
Medi-Cal County Inmate Program Agreements for FY 2021-2023
Related Items “On File” with the Clerk of the Board:
N/A